Dehydration is usually caused by excess fluid loss, such as from vomiting and diarrhea, and occasionally by inadequate fluid intake, such as when an infant does not take in enough milk through breastfeeding. Children who are moderately dehydrated are less interactive or playful, cry without tears, have a dry mouth, and urinate fewer than 2 or 3 times a day. Children who are severely dehydrated become sleepy or lethargic. Sometimes dehydration causes the concentration of salt in the blood to fall or rise abnormally. Changes in salt concentration make the symptoms of dehydration worse and can worsen lethargy. In severe cases, the child can have seizures or suffer brain damage and die.

Doctors examine children and note whether they have lost body weight. A loss in body weight over only a few days is very likely caused by dehydration. The amount of weight lost helps doctors decide whether the dehydration is mild, moderate, or severe.

Dehydration is treated with fluids and electrolytes, such as sodium and chloride, given by mouth. In severe cases, fluids given by vein (intravenously) or via a thin plastic tube passed through the nose into the stomach (nasogastric tube) are needed.

Treating Dehydration

Illnesses that cause vomiting and diarrhea can lead to dehydration in children. In infants, dehydration is treated by encouraging an infant to drink fluids that contain electrolytes. Breast milk contains all the fluids and electrolytes an infant needs and is the best treatment. If an infant is not breastfeeding, oral electrolyte rehydration solutions should be given. These can be bought as powders or liquids at drug or grocery stores without a prescription. The amount of solution to give a child in a 24-hour period depends on the child’s age, but generally should be about 1½ to 2½ ounces of solution for each pound the child weighs—thus, a 20-pound infant should drink 30 to 50 ounces total over 24 hours.

Children older than 1 year may try small sips of clear soups, clear sodas or juice diluted to half-strength with water, or popsicles. Plain water, juice, sports drinks, and colas are not good for treating dehydration at any age because the salt content of water is too low and because juice and colas have a high sugar content and ingredients that irritate the digestive tract.

Treatment of dehydration in children of any age who are vomiting is more effective if children are first given small, frequent sips of fluids about every 10 minutes. The amount of fluid can slowly be increased and given at less frequent intervals if the child can keep the fluid down without vomiting. If diarrhea is the only symptom, larger amounts of fluid can be given less often. Infants who are able to digest fluids over 12 to 24 hours can then resume drinking formula from a bottle. Older children can try broths or soups and bland foods (for example, bananas, toast, and rice). Infants and children who are unable to digest any fluids, or who develop listlessness and other serious signs of dehydration, may require more intensive treatment with fluids given by vein (intravenously) or electrolyte solutions given through a thin plastic tube (nasogastric tube) that is passed through the nose and down the throat until it reaches the stomach or small intestine.

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Behavioral and developmental problems can become so troublesome that they threaten normal relationships between the child and others or interfere with emotional, social, and intellectual development. Which of the following describes the treatment goal for behavioral problems in children?

Getting children to want to change their behavior
Getting parents to explain why they said "no"
Getting parents to punish undesirable behavior
Getting parents to reward good behavior

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